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DocuSign Envelope ID:7AC7CCCD-2FEA-4C09-B2A3-FA4F14F912CE <br /> NORTH CAROLINA LOCAL GOVERNMENT APPLICATION FOR FFY 2017 EMPG FUNDING <br /> Grant Period: October 1, 2016—September 30, 2018 <br /> 1.1 EM Agency Name Orange County Emergency Services <br /> 1.2 Street Address, City 510 Meadowlands Drive, Hillsborough,NC 27278 <br /> 1.3 EIN/Tax ID Number <br /> 1.4 DUNS 9 Digit Number 069420961 1.5 Zip Code+4 2 7 2 7 8 8 1 8 1 <br /> 1.6 SAM Registered? (Yes, No) Yes Expiration Date 22-Nov-2016 <br /> LOCAL EMERGENCY MANAGEMENT PROGRAM <br /> For 1.7 indicate actual percentage of time Emergency Management 1.9* 1.10 1.11 <br /> director devotes to work on only EM activities. Please do not <br /> include work time for EMS, 911, Fire Marshal,Safety activities, Time % Current <br /> ( ) Date of Employment <br /> etc. (e.g. 50%,75%, Salary in Current Position <br /> 1.7 EM Program Manager (Print/Type in Name Below) 100%) <br /> W. Kirby Saunders 100 $57,000 06/30/2014 <br /> Email: ksaunders @orangecountync.gov <br /> 1.8 County Finance Manager (Print/Type in Name Below) <br /> Gary Donaldson <br /> Email: gdonaldson@orangecountync.gov <br /> 1.12 Personnel Data: Complete for personnel supported with FFY 2017 EMPG Program funds <br /> a. All EMPG Program funds (Federal and match) allocated towards Local emergency management personnel? $ 137,556 <br /> b. All EMPG Program funds (Federal and match) allocated towards Non-Local emergency management $0 <br /> personnel? <br /> c. Total Number of Local emergency management full-time equivalent(FTE) personnel (including those 3 <br /> supported and not supported by the EMPG Program)? <br /> d. Number of Local emergency management full-time equivalent (FTE)personnel supported(fully or partially)by 0 <br /> the EMPG Program? <br /> e. Number of Local emergency management personnel supported(fully or partially) by the EMPG Program? 0 <br /> £ Cost Share or In-Kind Match explanation in detail? <br /> The county's match is the salaries of EM personnel <br /> *Area Coordinator must verify the percentage of time devoted to Emergency Management activities. <br /> EM Application Form 66 (Rev.7/16) Page 3 <br />